Initial experience with conservative treatment in cancer patients with osteonecrosis of the jaw (ONJ) and predictors of outcome.
BACKGROUND
Overall survival (OS) and outcome of cancer patients with bisphosphonate-associated osteonecrosis of the jaw (ONJ) using conservative treatment (chlorhexidine 0.12% rinse, intermittent antibiotics, and careful sequestrectomy) are unknown.


METHODS
In all, 33 ONJ patients were studied for OS and ONJ outcome.


RESULTS
Median duration of bisphosphonate treatment was 27 months (range 4-115) and was stopped in 25 (76%) patients. Nine (27%) cases presented with stage 1, 21 (64%) with stage 2, and 3 (9%) with stage 3 disease. During median follow-up of 23 months, 11 patients (33%) died (median survival 39 months), with no ONJ-related fatalities. Out of 30 assessable patients, 53% no longer had exposed bone, 37% had stable lesions, and 10% showed progressive necrosis. The hazard ratio for healing with doubling of bisphosphonate exposure was 0.419 [95% confidence interval (CI) 0.178-0.982; P = 0.045], stage 2 versus stage 1 disease 0.216 (95% CI 0.063-0.738; P = 0.015), and stage 3 versus stage 1 disease 0.084 (95% CI 0.008-0.913; P = 0.042). Cessation of bisphosphonate treatment did not influence outcome.


CONCLUSIONS
Conservative treatment of ONJ leads to mucosal closure in 53% of patients. Doubling the exposure time to bisphosphonates and higher stages of ONJ significantly reduce ONJ healing rates.
Van den Wyngaert
T
T
Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium. tim.van.den.wyngaert@skynet.be
Claeys
T
T
Huizing
M T
MT
Vermorken
J B
JB
Fossion
E
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D002710:Chlorhexidine / Q000627:therapeutic use; D015331:Cohort Studies; D016001:Confidence Intervals; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007568:Jaw / Q000473:pathology; D007571:Jaw Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000139:chemically induced / Q000628:therapy; D009367:Neoplasm Staging; D010020:Osteonecrosis / Q000139:chemically induced* / Q000473:pathology* / Q000628:therapy; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D016019:Survival Analysis; D016896:Treatment Outcome
D000891:Anti-Infective Agents, Local; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D002710:Chlorhexidine